lactancia materna y riesgo de cancer infantil

Lactancia materna

y riesgo de

cáncer pediátrico

―RESEÑA DE LA EVIDENCIA―

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ezLactancia materna y riesgo de cáncer pediátrico

1. Efecto de la lactancia materna en la morbilidad infantil.

2. Efecto de la lactancia materna en la mortalidad infantil.

3. Efecto de la lactancia materna en el desarrollo intelectual y motor.

4. Efecto de la lactancia materna en las enfermedades crónicas.

5. Efecto de la lactancia materna en la salud materna.

6. Beneficios económicos de la lactancia materna.

7. Bibliografía y Cuadros.

Junio 2002

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Children who are artificially fed or breastfed for only 6 months or less, are at anincreased risk of developing cancer before age 15. The risk of artificially fedchildren was 1-8 times that of long-term breastfed children, and the risk forshort term feeders was 1-9 times that of long term breast feeders.

Davis, MK. Infant Feeding and Childhood Cancer. The Lancet 1988 August ;332 (8607):365-368.

Los niños que son alimentados artificialmente o amamantados por sólo 6 me-ses o menos, están en un riesgo aumentado de desarrollar cáncer antes de los15 años de edad. El riesgo de los niños alimentados artificialmente fue de 1-8veces que los amamantados a largo plazo, y el riesgo para los alimentados acorto plazo fue de 1-9 veces que los alimentados con pecho a largo plazo.

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Greaves MF.Speculations on the cause of childhood acute lymphoblastic leukemia. Leukemia 1988; 2: 120–125.

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RESEÑA DE LA

EVIDENCIA

RESEÑA DE LA EVIDENCIA

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Autores,año y lugar Métodos Resultados significativos Conclusión

Mathur GP, et al (1993 May) Kanpur, India.

Between April 1991 and June 1992 in India, physicians compared data on 99 childhood cancer cases with data on 90 sex, age, and hospital matched controls to examine the relationship between duration of total breast feeding and exclusive breast feeding and childhood cancer.

The duration of total breast feeding was significantly longer for controls than cases (10 months vs. 8 months; p .05). The difference between mean duration of exclusive breast feeding between cases and controls was significant (4.6 months vs. 3.2 months; p .001). Controls were more likely to have undergone a longer duration of total breast feeding and exclusive breast feeding than were lymphoma cases (10 months vs. 6.15 months; p .01 and 4.6 months vs. 3 months; p .001, respectively). 58% of lymphoma cases had non-Hodgkins lymphoma. When the researchers compared other cancer groups and controls, no significant difference between the 2 groups existed in respect to total breast feeding and exclusive breast feeding

Estos resultados sugieren que la LM tiene un efecto protector contra el cáncer infantil. Además, estos indican que la LME proporciona efectos inmunológicos más beneficiosos que la LM complementada con la alimentación artificial. La alta tasa LME en la India puede explicar la baja incidencia de cáncer infantil (p.ej, alrededor de 6/100,000 vs. 18/100,000 en Israel).

Lactancia materna y cáncer infantil.

Lactancia materna y riesgo de cáncer pediátrico

Mathur GP, Gupta N, Mathur S, Gupta V, Pradhan S, Dwivedi JN, Tripathi BN, Kushwaha KP, Sathy N, Modi UJ, et al. Breastfeeding and childhood cancer. Indian Pediatr. 1993 May;30(5):651-7.


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Shu XO, et al. (1995 Feb) People's Republic of China

Data from a population-based case-control study of childhood cancer in Shanghai, including 82 lymphoma cases and 159 acute leukaemia cases and their age- and sex-matched community controls, were analysed.

After adjustment for potentially confounding variables, a slight, although non-significant, reduction in risk of lymphoma was observed among children who were breastfed as infants versus those who were not (odds ratio [OR] = 0.69; 95% CI: 0.3-1.7). The reduction was somewhat greater for children who had been breastfed longer and appeared to pertain primarily to Hodgkin's disease and to cases diagnosed before the age of 6 years. As expected, there was no reduction in risk of acute leukaemiaassociated with breastfeeding.

Aunque promover ni apoya fuerte ni refuta la hipótesis del estudio, estos datos sugieren que si la LM reduce realmente el riesgo de linfoma, su efecto protector entre niños chinos es probablemente modesto en la magnitud y concentración en ciertos subgrupos definidos por la prolongación de la LM, la edad del diagnóstico y el subtipo histológico del cáncer.

Lactancia materna y riesgo de leucemia aguda infantil.


Shu XO, Clemens J, Zheng W, Ying DM, Ji BT, Jin F. Infant breastfeeding and the risk of childhood lymphoma and leukaemia. Int J Epidemiol. 1995 Feb;24(1):27-32.


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Shu XO, et al. (1999 Oct) Minneapolis, USA.

A total of 1744 children with ALL and 1879 matched control subjects, aged 1-14 years, and 456 children with AML and 539 matched control subjects, aged 1-17 years.

Ever having breast-fed was found to be associated with a 21% reduction in risk of childhood acute leukemias (odds ratio [OR] for all types combined = 0.79; 95% confidence interval [CI] = 0.70-0.91). A reduction in risk was seen separately for AML (OR = 0.77; 95% CI = 0.57-1.03) and ALL (OR = 0.80; 95% CI = 0.69-0.93). The inverse associations were stronger with longer duration of breast-feeding for total ALL and AML; for M0, M1, and M2 morphologic subtypes of AML; and for early pre-B-cell ALL.

En este estudio, la LM estuvo asociada con un riesgo reducido de leucemia aguda infantil. De ser confirmado en estudios epidemiológicos adicionales, nuestros hallazgos sugieren que el futuro epidemiológico y los esfuerzos experimentales debieran ser dirigidos a la investigación de los efectos antiinfeciosos y/o inmunoestimuladores o inmunomoduladoresde la LM en la leucomogénesis en niños.

Lactancia materna y riesgo de leucemia aguda infantil.

ALL: acute lymphoblastic leukemia. AML: acute myeloid leukemia


Shu XO, Linet MS, Steinbuch M, Wen WQ, Buckley JD, Neglia JP, Potter JD, Reaman GH, Robison LL. Breast-feeding and risk of childhood acute leukemia. J Natl Cancer Inst. 1999 Oct 20;91(20):1765-72.

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ALL: acute lymphoblastic leukemia. HL: Hodgkin's lymphomaNHL: non-Hodgkin's lymphoma


Lactancia materna prolongada y protección contra leucemia y linfomas infantiles.


Bener A, etal. (2001 Jan) United Arab Emirates.

A case-control study comprising 117 patients, aged 2-14 years, with ALL, HL and NHL, as well as 117 controls matched for age, sex and ethnicity.

The median duration of breast-feeding among patients was significantly shorter than among controls, 7 (range 0-23) and 10 (range 0-20) months, respectively (P<0.0001). Breast-feeding of 0-6 months' duration, when compared with feeding of longer than 6 months, was associated with increased odds ratios (OR) for ALL (OR=2.47, 95% confidence interval (CI) 1.17-5.25), HL (OR=3.75, 95% CI 0.80-18.69), NHL (OR=4.06, 95% CI 0.82-22.59), and overall (OR=2.79, 95% CI 1.54-5.05). In multivariate analysis, breast-feeding duration continues to be an independent predictor of lymphoid malignancies (P=0.015).

La duración de la LM por más de 6 meses puede proteger contra leucemia aguda y linfomas infantiles.


Bener A, Denic S, Galadari S. Longer breast-feeding and protection against childhood leukaemia and lymphomas. Eur J Cancer. 2001 Jan;37(2):234-8.

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Lactancia materna y neuroblastoma, EEUU y Canadá.


Daniels JL, et al. (2002 Jun) USA y Canada.

Maternal reports of breast-feeding were compared among 393 children six months or older who had neuroblastoma and were identified through the Children's Cancer Group and the Pediatric Oncology Group and 376 age-matched case-control study.

Children with neuroblastoma were less likely to have breast-fed than control children (odds ratio (OR) = 0.6; 95% confidence interval (CI) = 0.5-0.9). The association between breast-feeding and neuroblastomaincreased with breast-feeding duration (0-3 months OR = 0.7, CI = 0.4-1.0; 13+ months OR = 0.5, CI = 0.3-0.9).

La LM estuvo asociada inversamente con neuroblastoma y debería ser promocionada entre las madres sanas. La investigación adicional sobre los posibles mecanismos de de esta asociación deberían garantizarse.


Daniels JL, Olshan AF, Pollock BH, Shah NR, Stram DO. Breast-feeding and neuroblastoma, USA and Canada. Cancer Causes Control. 2002 Jun;13(5):401-5.

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Lactancia materna y el riesgo de leucemia infantil: un meta-análisis.


Kwan ML, et al. (2004 Nov-Dec) California, USA.

A fixed effects model was employed to systematically combine the results of 14 case-control studies addressing the effect of short-term (< or = 6 months) and long-term (>6 months) breastfeeding on the risk of childhood ALL and/or AML. Subgroup analyses of studies that did and did not adjust for SES were also performed.

A significant, negative association was observed between long-term breastfeeding and both ALL risk (odds ratio [OR]=0.76; 95% confidence interval [CI] 0.68, 0.84) and AML risk (OR=0.85; 95% CI 0.73, 0.98). Short-term breastfeeding was similarly protective for ALL and AML. Results for studies that adjusted and did not adjust for SES were not significantly different from the results for the 14 studies combined.

Este meta-análisis mostró que tanto la LM a corto plazo como a largo plazo redujo el riesgo de ALL y AML infantil, sugiriendo que el efecto protector de la LM no pude limitarse a ALL como se suponía antes. La tendencia potencial introducida por tasas de participación diferentes para casos y control muestra que la diferencia en el SES puede minimizarse implementando estudios de casos y controles más grandes comparando el SES, basados en la población.

ALL: acute lymphoblastic leukemia. AML: acute myeloid leukemia SES: socioeconomic status


Kwan ML, Buffler PA, Abrams B, Kiley VA. Breastfeeding and the risk of childhood leukemia: a meta-analysis. Public Health Rep. 2004 Nov-Dec;119(6):521-35.

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Revisión de estudios de casos y controles relacionados con la LM y reducción del riesgo de leucemia infantil.


Guise JM, et al. (2005 Nov) Oregon, USA.

We sought studies providing data regarding the association of breastfeeding and occurrence of childhood leukemia. Studies were identified by using Medline, HHS Blueprint for Action on Breastfeeding, US Department of Health and Human Services Office on Women's Health, Cochrane Database of Systematic Reviews, National Centre for Reviews and Dissemination, reference lists, and national experts. Methodologicquality was evaluated for each study by using criteria from the US Preventive Services Task Force and the National Health Service Centre for Reviews and Dissemination.

We reviewed 111 citations to identify 32 potentially eligible full-text articles. Of the 10 studies reviewed, only 4 were sufficient to provide at least fair-quality evidence regarding the association between maternal breastfeeding and childhood leukemia. Studies conflicted regarding the protective effect of breastfeeding on childhood leukemia. In the 2 largest and highest quality studies, breastfeeding was associated with a significant risk reduction in one study with longer breastfeeding duration, reflecting greater protection, and a nonsignificant but suggestive difference in the other. Taken together, half of the studies associated breastfeeding with a lower risk of acute lymphocytic leukemia.

Hay pocos estudios de alta calidad que examinan el potencial de un efecto protector de la LM para la leucemia infantil. Además, los pocos estudios que existen discrepan en cuanto a la asociación. Se estima que los EEUU gastan 1.4 billones de dólares anualmente para el tratamiento de la leucemia infantil. Los pacientes, los clínicos, y los creadores de política no tienen los datos que ellos necesitan para tomar decisiones en cuanto a esta medida preventiva potencial importante.


Guise JM, Austin D, Morris CD. Review of case-control studies related to breastfeeding and reduced risk of childhood leukemia. Pediatrics. 2005 Nov;116(5):e724-31.

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Lactancia materna y cáncer infantil: una RS con meta-análisis.


Martin RM, et al. (2005 Dec) Bristol, United Kingdom.

We undertook a systematic review of published studies investigating the association between breast-feeding and childhood cancers using Medline (1966 to June 2004), supple-mentedwith auto alerts and manual searches. Analyses are based on odds ratios for specific cancers among those ever breast-fed compared with those never breast-fed, pooled using random-effects models.

Forty-nine publications were potentially relevant; of these, 26 provided odds ratio estimates for at least one childhood cancer outcome and were included in metaanalyses. Overall, 92% of the studies were case-control studies, 85% relied on long-term recall of feeding history, only 8% examined breast-feeding exclusivity and control response rates were under 80% in over half. Metaanalyses suggested lower risks associated with having been breast-fed of 9% (95% CI = 2-16%) for ALL, 24% (3-40%) for HL and 41% (22-56%) for neuroblastoma, with little between-study heterogeneity. The estimates for HL and neuroblastoma, however, were driven by single studies. There was little evidence that breast-feeding was associated with acute nonlymphoblastic leukemia, NHL, central nervous system cancers, malignant germ cell tumors, juvenile bone tumors, or other solid cancers.

Haber sido amamantado está asociado inversamente con ALL, HL y neuroblastoma en la infancia, pero las explicaciones no causales son posibles. Incluso de ser causal, la importancia para la salud pública de estas asociaciones puede ser pequeña. Nuestras estimaciones sugieren que el aumento de la LM de un 50% a un 100% prevendría en la mayor parte el 5% de casos de leucemia aguda y linfoma infantiles.

ALL: acute lymphoblastic leukemia. HL: Hodgkin's lymphoma. NHL: non-Hodgkin's lymphoma


Martin RM, Gunnell D, Owen CG, Smith GD. Breast-feeding and childhood cancer: A systematic review with metaanalysis. IntJ Cancer. 2005 Dec 20;117(6):1020-31.

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AltinkaynakS, et al. (2006 May) Erzurum, Turkey

We investigated this issue in a case-control study comprising 137 patients, aged 1 to 16 years, with acute lymphocytic leukemia (ALL), acute myeloid leukemia (AML), Hodgkin or non-Hodgkin lymphoma, in addition to 146 controls matched for age and sex.

The median duration of breast-feeding among patients was shorter than that of controls (10 vs 12 months). Patients with ALL and AML had shorter mean breast-feeding duration compared with healthy children (P = 0.001 and P < 0.001, respectively). The shortest mean breast-feeding duration was noted in the children with AML. Breast-feeding for a duration of 0 to 6 months, when compared with feeding of longer than 6 months, was associated with increased odds ratios (ORs) for ALL [OR = 2.44, 95% confidence interval (CI) = 1.17-5.10], AML (OR = 6.67, 95% CI = 1.32-33.69), Hodgkin lymphoma (OR = 3.33, 95% CI = 0.60-18.54), non-Hodgkin lymphoma (OR = 1.90, 95% CI = 0.68-5.34) and overall (OR = 2.54, 95% CI = 1.51-4.26).

Nuestras conclusiones sugieren que la LM por más de 6 meses es protectora contra malignidades linfoides en la infancia, especialmente para AML y ALL.

AML: acute myeloid leukemia ALL: acute lymphoblastic leukemia.

Duración de la lactancia maternay leucemia aguda y linfoma infantiles en una muestra de niños turcos.


Altinkaynak S, Selimoglu MA, Turgut A, Kilicaslan B, Ertekin V. Breast-feeding duration and childhood acute leukemia and lymphomas in a sample of Turkish children. J Pediatr Gastroenterol Nutr. 2006 May;42(5):568-72.

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COG, Sadd-lemire S, et al. (2006 Jun) North Carolina, USA

We used data from a large case-control study in the United States and Canada. Cases were children under age 16 years who were diagnosed with Wilms tumor from 1999 to 2002 and were participating in the National Wilms Tumor Study. Controls were identified by random-digit dialing and were age and region matched to cases. Mothers of 501 cases and 480 controls provided information on breast-feeding by telephone interviews.

Breast-feeding was associated with a reduced risk of Wilms tumor [adjusted odds ratio (OR) = 0.7; 95% confidence interval (CI) = 0.5-0.9]. Longer duration did not provide any additional reduction in risk. When stratified by maternal education, breast-feeding lowered risk among children whose mothers had less than a college education (OR = 0.6; 95% CI = 0.4-0.8) but not for mothers who had a college degree or more (OR = 1.1; 95% CI = 0.6-1.9).

Los resultados de este estudio son sugestivos de una asociación entre LM y una reducción en el riesgo de tumor de Wilms, pero la investigación adicional es necesaria para confirmar esta relación.

Lactancia materna y turmor de Wilms: un informe del Grupo de Oncología Pediátrica


Children's Oncology Group, Saddlemire S, Olshan AF, Daniels JL, Breslow NE, Bunin GR, Ross JA. Breast-feeding and Wilms tumor: a report from the Children's Oncology Group. Cancer Causes Control. 2006 Jun;17(5):687-93.

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AHRQ PublicationNo 07-E007. (April 2007) USA

We identified four systematic reviews or meta-analyses that examined the relationship between breastfeeding and childhood leukemia. We have elected to describe in details only the Guise 2005 systematic review and Kwan 2004meta-analysis because they superseded the Beral 2001 meta-analysis and Davis 1998 systematic review.

We used a random-effects model to combine SES-adjusted odds ratios of ALL in relation to short-term (≤ 6 months) and long-term (> 6 months) breastfeeding from UKCCS103, CCG107study, and Dockerty 1999 (Table 17). Rosenbaum 2000 was excluded fromthe analysis because the duration of breastfeeding was not reported. The results from our meta-analysis suggest that long-term breastfeeding is associated with a reduction in the risk of ALL (OR 0.80; 95%CI 0.71 - 0.91).

Se concluye que existe asociación entre una historia de lactancia materna de una duración mínima de 6 meses y una reducción en el riesgo de ALL y AML.

Relación entre lactancia materna y leucemia infantil. Un meta-análisis.


Evidence Report/Technology Assessment. Number 153. Breastfeeding and Maternal and Infant HealthOutcomes in Developed Countries. Relationship between Childhood Leukemia and Breastfeeding. Agency for Healthcare Research and Quality U.S. Department of Health and Human Services and Tufts-New England Medical Center Evidence-Based Practice Center Boston, Massachusetts. AHRQ Publication No. 07-E007. April 2007.

acute lymphocytic leukemia (ALL)

acute myelogenous leukemia (AML)

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Ortega-García JA, et al (Jan-Feb 2008) Spain.

Maternal reports of full breastfeeding, collected through personal interviews using the PaediatricEnvironmental History, were compared among 187 children 6 months of age or older who had PC and 187 age-matched control siblings.

The mean duration of full breastfeeding for cases were 8.43 and 11.25 weeks for controls. Cases had been significantly more often bottle-fed than controls (odds ratio (OR) 1.8; 95% confidence interval (CI) 1.1–2.8). Cases were significantly less breastfed for at least 2 months (OR0.5; 95% CI 0.3–0.8), for at least 4 months (OR 0.5; 95% CI 0.3–0.8), and for 24 weeks or more (OR 0.5; 95% CI 0.2–0.9).

La LM estuvo asociada inversamente con cáncer pediátrico, la protección aumenta con la duración de la lactancia exclusiva. Es necesaria la investigación adicional sobre los mecanismos posibles de esta asociación. Mientras tanto, la LM debe ser promocionada entre las madres.

Lactancia materna exclusiva y cáncer pediátrico.


Juan A Ortega-García, Josep Ferrís-Tortajada, Alberto M Torres-Cantero, Offie P Soldin, Encarna Pastor Torres, Jose L Fuster-Soler, Blanca Lopez-Ibor and Luis Madero-López. Full breastfeeding and paediatric cancer. J Paediatr Child Health 44 (2008) 10–13.

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Bener A, et al (April2008) Qatar.

The study group comprised of 169 patients with acute lymphocytic leukemia (ALL), Hodgkin's (HL) and non-Hodgkin's lymphoma (NHL), age =or<15 years, and 169 healthy controls, matched to patients by age and sex. Mothers of all study subjects provided information via telephone about the history of breastfeeding and parameters seen as proxies for viral infection.

The mean age+/-SD of cases was 5.44+/- 3.29 years and of control subjects 5.51+/-3.62 years. The male/female ratio was 1.73. Overall, the mean number of months of breastfeeding in the male patients and controls was 9.1 (95% confidence interval [CI] 7.9-10.4) and 12.1 (95% CI 11.0-13.4), respectively (P<0.001), and in the female patients and controls 8.4 (95% CI 6.9-10.1) and 11.5 (95% CI 10.0-13.0), respectively (P<0.01). In 103 ALL patients, a shorter period of breastfeeding (0-6 months duration), was associated with increased odds ratio (OR) for males (OR=3.1, 95% CI 1.4-6.8) and females (OR=2.2, 95% CI 0.8-6.32) as compared to breastfeeding longer than 6 months. In 103 ALL patients, 32 HL and 34 NHL patients, there were no statistically significant differences in the duration of breastfeeding between the male and female patients and their respective controls. In multivariate analysis, statistically significant risk factors for the development of childhood lymphoid malignancy were: a shorter duration of breastfeeding, lower age and level of education of mother and higher income, larger size of accommodation and birth order in the family.

El presente estudio confirma que una mayor duración de la LM tiene un efecto protector contra ALL y HL. Los factores adicionales que se encuentran asociados con un riesgo elevado de neoplasia linfoide fueron edad y nivel educativo bajos de la madre. Todos estos factores pueden estar relacionados con un mayor riesgo de infecciones en la infancia temprana.

¿La lactancia materna prolongada reduce el riesgo de leucemia y linfomas infantiles?


Bener A, Hoffmann GF, Afify Z, Rasul K, Tewfik I. Does prolonged breastfeeding reduce the risk for childhood leukemia and lymphomas? Minerva Pediatr. 2008 Apr;60(2):155-61.

acute lymphocytic leukemia (ALL); Hodgkin's lymphoma (HL)

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Childhood cancer. Several studies have examined associations between formula-feeding and childhood

leukemia, based on the hypothesis that immunoactive factors in breast milk may prevent viral infections

implicated in leukemia pathogenesis. Two meta-analyses found a 1.3-fold higher risk of acute lymphoblastic

leukemia among formula-fed children, compared with children who were breast-fed for greater than 6

months. Kwan et al. found a 1.2-fold higher risk of acute myeloid leukemia among formula-fed infants,

compared with infants breast-fed ≥6 months.

July 2009

―Semana Mundial de la Lactancia Materna 2009―

"Lactancia Materna: una respuesta vital en emergencias".

lactancia materna y riesgo de cancer infantil

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